MMA and CO 2 Laser MLG in Obstructive Sleep Apnea Syndrome: New Parameters of Success

Abstract

Objective: To describe the results obtained by maxillomandibular advancement associated with CO₂ laser midline glossectomy in the surgical treatment of moderate to severe obstructive sleep apnea syndrome, based on polysomnographic analysis of macrostructure and microstructure of sleep.

Method: From the period of February 2005 to December December 2008, 22 patients with moderate and severe OSAS,with or without maxillomandibular anteroposterior discrepancies from the Otorhinolaryngology–Head and Neck Surgery Nucleus of Sao Paulo were selected. These patients underwent MMA with CO₂ Laser MLG. Evaluation included physical examination, cephalometric analysis, and polysomnographic data before and after surgery. The sleep study parameters used were: AHI, MD, minimum Sat O₂, time of Sat O₂ desaturation below 90%, sleep stages N1, N2, N3, and REM. The cephalometric parameters used were: SNA, SNB, PAS, PP2-PP2. Evaluation of eventual differences in pre- and postoperative data were investigated with the appropriate statistical tools. The surgical treatment proved to be effective in 8 out of 22 of the cases (36.36%), according to international criteria of normality. On the other hand, for these patients the AHI was not the best parameter to evaluate the therapeutic success.

Results: The DM (60.18% of improvement), stage N3 (59.9% of improvement), and time of Sat O₂ <90% measured in minutes (81.81% of improvement) demonstrated they were the best instrument for characterizing the laboratorial control of desease.

Conclusion: The surgical treatment perfomed with MMA associated with CO₂ laser MLG was effective in treating patients with moderate to severe OSAS. The improvement using the most accepted parameter by the international community (AHI below 5) was 8 out of the 22 (36.36%). The AHI was not the most accurate instrument to evaluate the control of the desease. Although MD, stage N3, and time of Sat O₂ below 90% measured in minutes demonstrated to be more appropriate indicators of surgical control of the desease. The time of Sat O₂ <90% was the best parameter in the evaluation of the surgical treatment.